Cemental tear: To know what we have neglected in dental practice

Abstract

Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction.

Surgical Treatment of a Cemental Tear‐Associated Bony Defect Using Hyaluronic Acid and a Resorbable Collagen Membrane: A 2‐Year Follow‐Up

“…The CeT diagnosis is always difficult and, at times, it is an underdiagnosed periodontal condition, originally described in the literature as an incidental histological finding from autopsy materials …”

“…The main clinical features of CeT are: increasing probing depth (PD), periapical and periodontal tissue breakdown, pain, gingival swelling, suppuration, and tooth mobility. The histological findings have shown adherent periodontal ligament fibers, cementum lamellae, and cementocytes . Radiographically, it often presents as a periodontal lesion with vertical bone loss or periapical lesion .…”

Actinomycosis as a Rare Local Manifestation of Severe Periodontitis

“…As always-when looking at isolated destructive processes-the question arises as to which specific (local) causes can explain such devastating tissue involvement. Several explanations for isolated defects have been described in the literature: vertical root fractures [22], endoperiolesions [23], functional overload [24], foreign body reactions [25], and cemental tears [16,26]. Clinicians must always be aware of such potential implications, but a clear identification of the causative agent is sometimes very difficult clinically.…”

Management and 5-year follow-up of tooth with bilateral cemental tear and complete pulp canal obliteration

“…Jeng et al . have described cemental tear as a special kind of root surface fracture, contributing to periodontal and periapical breakdown 4. Treatment approaches recommended include: scaling and root planning open flap debridement, bone graft, regenerative periodontal treatment, and extraction in cases of poor prognosis.…”